Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 038621 | CT |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 038621 | CT |
NPI | 1104821958 |
---|---|
Provider Name | Robert A Arciero |
First Address | Farmington, CT 06030-2212 |
Second Address | Farmington, CT 06030-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 26/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1386219 | (05) | CT |
H16875 | (02) | CT |